FORM A THE TRIBUNAL

1150 North First Street, Suite 100

Reset Form
Self-Testimony San Jose, CA 95112-4966
Tel. No. 408-983-0219 - Fax No. 408-983-0181

Parish Name City

QUESTIONNAIRE FOR THE BRIDE/GROOM: To be filled in by Priest and signed by Bride/Groom

The Priest will instruct the party regarding the sacred character and binding force of an oath, and then ask him/her to
take the following oath: Do you swear to tell the whole truth and nothing but the truth in answer to all the questions
that shall be proposed to you?

1. Full Name Address

Daytime Phone No. City State
E-Mail Address Country
2. Date of Birth (mm/dd/yyyy) Place of Birth
City State
Country
3. Father’s Name Mother’s Name
Father’s Address Mother’s Address
Father’s Religion Mother’s Religion
4. Have you been baptized?  Yes  No Where? (Exact Name and Church Location)
When? (mm/dd/yyyy) Name of Church
Baptized in what Religion? City State
 Practicing Country
 Not Practicing /Current Religion
If a member of an Eastern Catholic Church, N.B. A Baptismal Certificate, issued not more than
please state which one: six months previously, must be obtained
(even for Non-Catholic, if this is at all possible.)
5. [For Catholics only] Have you received your First Holy Where? (Exact Name and Church Location)
Eucharist/ Communion? Name of Church
 Yes  No City State
When? (mm/dd/yyyy) Country
6. In what Parish do you reside now? How long have you resided in this Parish
Name of Church
City State Have you formally joined a non-Catholic Community or
rejected the Catholic Faith?
Country  Yes  No
7. Name of the person you intend to marry?
8. How long have you known this person? When did you become engaged: (mm/dd/yyyy)
(If depondent is not yet 18 years of age)
Have your parents/guardians consented to this marriage?  Yes  No If no, why not?
9. Have you ever been married or attempted marriage even if only civily or by common law?  Yes  No
If so, state to whom, where, and before whom?
Name Place Witness
Does this marriage bond still exist?  Yes  No
If not, how was it dissolved?  Death?  Catholic Declaration of Nullity?  Civil Dissolution?  Or Civil Annulment?
[For Catholic Party]
If married by a minister or civil official, did you have a Church dispensation to do so?  Yes  No
If so, please state name of the Diocese
Date of Dispensation (mm/dd/yyyy)

Page 1 of 2 Revised: October-2019

Form A – Page 2

10. The Priest/Deacon will prudently inquire if the following is required, such as mixed religion (c.c. 1124-1126) or
notorious rejection of the Catholic faith. The usual promises are required. (He should also be aware of the situations
requiring permission in Canon 1071. Obligation to former spouse or children is covered in the diocesan faculties).
Note: If Yes to any of the items, a Permission or Dispensation must be requested from the Tribunal.

a. Mixed Religion (Non-Catholic is baptized)  Yes  No

b. Disparity of Worship (Non-Catholic has never been baptized)  Yes  No

c. Are you aware of any physical or psychological problem which would make it impossible for you to have
normal marital relations?  Self  Yes  No
 Intended Spouse  Yes  No
d. Are you undergoing any psychological counseling or treatment?  Yes  No
Is your intended spouse undergoing any psychological counseling or treatment?  Yes  No

e. Are you related to your intended spouse by blood? (Consanguinity)  Yes  No

f. Are you related to your intended spouse by marriage? (Affinity)  Yes  No

g. Are you bound by the impediment due to Holy Orders, or public perpetual vow of chastity in a religious
institute?  Yes  No

11. Are you entering this marriage freely, i.e., free from all compulsion, whether exerted by persons or circumstances?
 Yes  No
12. The Priest will clearly explain the teaching of the Church regarding indissolubility, fidelity, primary purposes of
marriage and birth control. He then asks:
a. Do you intend a permanent marriage, to be dissolved only by death?  Yes  No

b. Do you intend in this marriage to remain faithful to your spouse?  Yes  No

c. Do you intend to give your spouse the right to have children?  Yes  No

d. Does the person you are marrying have these same intentions?  Yes  No

13. Is there anything else you believe you should make known about the proposed marriage?

Printed Name and Signature of Bride/Groom

Printed Name and Signature of Priest Please affix

Parish Seal here

Name of Priest/Deacon to be Delegated (if necessary)

Place and Date Signed

Page 2 of 2 Revised: October-2019